 December 2002 • Volume 8 • Number 12 |
At press time, Congress was considering a technical measure allowing HHS to alter the formula for the Medicare fee schedule and prevent physicians' fees from dropping 4.4 percent for 2003. Following the 5.4 percent drop for 2002, you may be wondering what your options are for participation in Medicare.
The Centers for Medicare & Medicaid Services may extend the deadline for altering your Medicare participation status beyond Dec. 31, and it may be best to make your participation decision in late December (or later, if the deadline shifts). Without suggesting which way to go, the Academy wants to remind you of these options:
Being a participating physician. You may sign a participation agreement and accept Medicare's allowed amount as payment in full for all your services to Medicare patients. Typically, the allowed amount is the 80 percent Medicare pays, plus patients' co-payment of 20 percent. The Medicare allowed amount is 5 percent higher for participating physicians than for nonparticipating physicians.
Being a nonparticipating physician. You may charge your Medicare patients up to about 9.25 percent more than the Medicare allowed amount for participating physicians. However, your total revenue from sources such as Medicare and patient co-payments might not exceed your revenue as a participating physician, given factors including collection costs and bad debts.
Using private contracting. You may submit an affidavit to Medicare, agreeing to opt out of any Medicare payments for two years, and may contract with all your Medicare patients for them to pay you outside of Medicare. Under private contracting, there is no limit on what a physician may charge a Medicare patient.
For details about these options, go to http://www.aafp.org/mcareoptions.xml.
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Copyright © 2002 by
American Academy of Family Physicians.